Readers’ letters, 04/09/08: Inspection regime, home care contracts, keep personalisation simple

Inspection regime improved, says CSCI

As the regulator for social care, the Commission for Social Care Inspection has supported the development of Comprehensive Area Assessment, particularly the need for it to address the needs of people whose circumstances make them vulnerable. Far from a weakening of the current inspection regime (“Ministers in drive to reduce burden on children’s and adults’ services with limited visits”, https://www.communitycare.co.uk/109052), CAA will enhance the focus in this area.

CSCI has over the past 18 months increased its scrutiny of councils and providers of services. Adult safeguarding is a key part of every new inspection of council services. We have now inspected and reported on arrangements in 19 councils, and our inspection programme for this year includes a further 31 inspections. This programme of inspections will continue as part of our core business.

Also this year, for the first time, we have introduced a key threshold into councils’ star ratings. This means that a council’s adult social care cannot be judged to be better than “good” for delivery of all outcomes if their performance in the outcome area of dignity and respect is only “adequate”. Similarly a “poor” outcome for dignity and respect would mean that the overall outcome score could not be greater than adequate.

Finally, we have undertaken an examination of the strengths and shortcomings of the current safeguarding framework.

Paul Snell, Chief inspector, Commission for Social Care Inspection

When contracts conflict with care

While I have every sympathy with the United Kingdom Home Care Association and its members’ concerns about the rising cost of fuel (“High fuel costs may lead care providers to refuse contracts”, https://www.communitycare.co.uk/109120), their apparent freedom to “refuse contracts” means that there is an obvious risk that vulnerable people’s needs will not be met.

This is a good example of why providing public services through private contractors is not always the great idea that politicians say it is.

Councils are now almost totally reliant on private “outsourced” providers, with directly provided home care almost non-existent. Home care is a core service and should not be allowed to fail.

Other essential public sector workers such as district nurses’ fuel costs are also rising and this impacts negatively on NHS budgets.

However, I haven’t heard of them being able to simply refuse to take on new work for this reason. Private providers have a contract to care, public organisations have a duty to care. Clearly the former responsibility does not carry the same weight as the latter.

Peter Scourfield

Senior lecturer in social work

Anglia Ruskin University

Personalisation: make it simple

Zoë Porter of CSIP invites us again (“Launching Personalisation”, https://www.communitycare.co.uk/109132) to welcome personalisation, but I keep encountering people who like the idea but who are mystified as to the substance of it.

The concepts need to be grounded or else they will either be dismissed by the cynical as so much rhetoric – a fig-leaf for rationing, or else will be invested by enthusiasts with a thousand and one imposed meanings which will confuse, undermine, and compromise the possibility of a coherent vision.

The concept for direct payments emerged from disabled people and ownership was vested in the disability movement. Consequently, the idea and language behind DPs had a relevance that was recognisable and readily applicable. Unless people can see how the new approach works, then it will remain an official invention that will suffer from an accretion of top-down rules.

It is essential that the key ideas should be expressed in far more practical language than has so far generally been done. Some attempts from the perspective of “critical friend” have been published on the Independent Living Association website.

Barry Ruffell

Independent Living Association,

W Sussex

New research on individual budgets

SCIE is preparing a research briefing on co-production, as well as updating our earlier review of evidence on individual budgets. We are also producing a rough guide to personalisation that will help frontline staff.

Julie Jones

Chief executive, SCIE

Residents resist assistive technology

t is very unfortunate that the views of the residents of Ajex House sheltered housing in the London Borough of Hackney were not part of the SCIE research into assistive technology for older people (“Research on older people’s use of assistive technology”, https://www.communitycare.co.uk/109115).

The 48 residents are mainly Jewish ex-service personnel and their partners who have a fine understanding of the implications of excessive state intrusion into citizens’ lives. They currently have a warden who they trust to respond to their varied needs but this service is being replaced by a minimal floating warden scheme alongside the drive to impose technological care.

The residents have conducted a long campaign to keep their warden and some have refused to participate in the assessment process for telecare saying “we can’t withdraw our labour but we can refuse to be assessed”. They do not wish to be monitored by big brother cameras and gadgets and wish to retain the personal, consistent and confidential service they have at present from the warden.

It is questionable research methodology, quoted in the SCIE report, that defines a positive approach as acceptance of the service. This ascribes a negative connotation and stigma to those refusing the service with no acknowledgement of the civil liberties issues involved in state surveillance systems. The Ajex residents requested details of the criteria of the assessment and scrutinised the qualifications of the assessors. They were dissatisfied on both counts and challenged some assessments that took place as asking highly intrusive personal questions in a tick box approach – as a result the process has been paused.

Supported by local councillors the residents, many aged over 90 years, simply want to keep their warden. It doesn’t seem a lot to ask.